Atraumatic grade five renal injury

A young female in her 30s presented with right lumbar and flank pain after performing deadlift exercises at the gym. Whilst initially thought to have a presentation of acute musculoskeletal back pain, she had two unexpected syncopal episodes whilst in the waiting room. She went on to be diagnosed with an unexpected grade V renal injury and active retroperitoneal haemorrhage. She became haemodynamically unstable and was treated using the hospital major haemorrhage protocol. The patient was ultimately transferred to a tertiary centre, where she underwent renal artery embolisation successfully.Atraumatic renal injury is rare and has only been described in a few case reports. Classic signs, as well as point-of-care ultrasound, are sometimes unreliable for diagnosing retroperitoneal haemorrhage. Therefore, emergency physicians must keep renal injuries within the differential diagnosis of flank pain even in the absence of overt trauma.